A public health approach to…….five quick thoughts

“Greg 

What’s a public health approach to……………whatever the issue de jour is……”
All public health types often asked this question

Answer varies according to question, who’s asking and context.
Here’s 5 thoughts 
1)

Public health approach” to is NOT ‘prevention’

It is the application of a set of skills to an issue or problem
2)

One definition – What is “Public Health”

Here “public health” is defined as the science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.
Think about that definition really carefully. 

Many of the individual words have meaning, they are not carelessly chosen.
3)

Public Health Services vs other policy and regulatory interventions to achieve an outcome 

Public health funding is used in local government to provide or commission some services, such as stop smoking, weight management or sexual health services; these are often considered “public health”. However, other services also make a substantial contribution to the health of the public, for example general practice, cardiology, housing support or welfare benefits advice. 
Staff whose salary is paid for by the public health grant don’t have a monopoly on initiatives to improve health and wellbeing.
Provision of services is one way of achieving better health and well being. 
Others include structural and policy initiatives (making the healthy choice easier), education, regulation, and tax / or subsidy. In some areas the response is about analysis, in others it may be about developing service models, ensuring high and equitable coverage of high value interventions, developing health enabling policies or designing evaluations and cost benefit approaches. What matters most is the outcome that is achieved, the method – whether this be policy development, regulatory issues or service delivery is secondary to the outcome.
4)

A “public health approach”

The skill sets that are applied to these areas have been published many times; these are best summarised as:
Epidemiology – a short hand term for the methods used to describe “need”, “demand” or both. This covers what do we know about a given problem, how frequently it occurs, in which groups, how it is changing, what causes it and what outcomes it leads to.
Evidence based policy and practice  – given a particular health and well being problem, what does the available evidence tell us is the best way to prevent this problem or to meet this need as efficiently and equitably as possible. 

Economic analysis – what is the most cost effective way of addressing a problem, that will lead to the optimal return on any investment of money, time or human resource. Economic analysis will also enable a better understanding of where costs and benefits fall.

Evaluation – the use of a range of skills and techniques to test whether a service, programme or policy is achieving the expected goals.

Ethics – given all we know, what is the “right” thing to do to optimise the health of the population as a whole, and to minimise inequality.

They can be applied to hyper acute stroke, in growing toenails or poverty.

Not much ‘commissioning services to ……..’ in this list
The key contribution of the “public health specialist” is the application of this set of skills and methods to an issue or problem. The approach can be applied from areas as diverse as “tacking poverty” to “planning for hyper acute stroke care”. A key role of public health staff is to apply the methodology systematically to immediate and more upstream determinants of the health. 

5)

Some examples of “a public health approach to”….
a)

A public health approach to violence prevention for England 

Many of same features

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216977/Violence-prevention.pdf

  • Describe the phenomena
  • Describe the impact and the downstream consequences
  • Describe the upstream risk factors – Quite a long way upstream
  • Local level interventions to address the issue
  • * Supporting parents and families 
  • * Developing life skills in children and young people 
  • * Working with high risk youth and gangs 38 Reducing the availability and harmful use of alcohol 
  • * Community interventions 
  • * social norms that support violence 
  • * Identification, care and support
  • National policies that will also support the objective

You’ll note that it’s not a long list of stuff to do, it’s a thoughtful approach.

b)

Whole systems and mental health

I can’t better that Jim McMannus wrote on this. This is essentially “the public health approach to” mental health.

https://jimmcmanus.wordpress.com/2016/01/08/a-whole-system-approach-for-mental-health/
https://www.slideshare.net/mobile/jamesgmcmanus/piers-simery-and-jim-mcmanus-the-journey-to-whole-system-introduction-to-mental-health-needs-assessment-workshop
c)

Alcohol as a public health issue.

Neatly described in the Nature by Gilmore et al

 

http://www.nature.com/nrgastro/journal/v13/n7/full/nrgastro.2016.70.html

 

Key features of ‘a public health approach to’ this one 

Some descriptive 

  • why its an issue
  • description of issue – trends in the thing concerned, and its risk to health
  • typically described in standard epi terms – person, place, time
  • nature, scale and effects – health, social, other

interventions to reduce avoidable harm – in this case focused on affordability, advertising, price, availability

Linking alcohol prices to the cost of living.

  • Minimum pricing.
  • Pricing on alcohol content
  • Minimum unit pricing
  • Earmarked alcohol taxes
  • Combining taxation
  • Restricting discounts

 

Reducing physical availability

  • Restricting trading hours
  • Limiting outlet density.
  • Purchasing age laws

 

Restricting alcohol marketing

  • Self-regulation
  • Total or partial bans.
  • Counter-advertising.

 

You will note no comment on ‘services’ and ‘treatment’

 

General issues and principles can be applied to anything.

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